New Breast Cancer Screening Guidelines: What Women Need to Know

New guidance from the American College of Physicians (ACP) says all average-risk females aged 50-74 should undergo biennial mammography screening for breast cancer.

The new guidelines from ACP add to the confusion of screening recommendations, says Lauren Carcas, M.D., a medical oncologist with Baptist Health Herbert Wertheim Cancer Institute.

“Generally, this recommendation is based on a risk-based screening approach to determine who needs more frequent and/or aggressive screening versus who could safely space out screening frequency,” Dr. Carcas says.

She adds that disparities exist in access to breast cancer screening and treatment and that the new recommendation “assumes that all women have equal access to individualized discussions and nuanced risk-assessment through either their primary care or gynecologic physicians.”

Ultimately, Dr. Carcas believes the biennial screening recommendation will potentially widen the disparities and increase the likelihood of missing cancers in the populations that are already impacted by barriers to care.

Lack of Consensus on ACP’s Screening Guidelines

The ACPs new recommendation now aligns with the recommendation of the United States Preventive Services Task Force (USPSTF), Dr. Carcas notes. However, it still deviates from the annual mammography recommendation by other groups, including the National Comprehensive Cancer Network, the American Society of Breast Surgeons, the American College of Radiology and the Society of Breast Imaging.

The screening interval remains the most consequential disagreement between all of the medical societies and the USPSTF, according to Dr. Carcas. Additionally, the new guidance from the ACP recommends against supplemental MRI or ultrasound for dense breast tissue and only recommends digital breast tomosynthesis, or 3D mammography. However, she notes that the radiologic societies very strongly recommend the addition of breast ultrasound and/or MRI for more complete and accurate imaging.

The Rational Behind the Recommendation

The decreased frequency of screening was recommended by the ACP to reduce false positive reports from annual screenings. However, Dr. Carcas notes that there is “a gap in evidence” regarding any mortality difference between annual and biennial screening.

“There has not yet been a randomized control trial specifically looking at the mortality difference between the two approaches,” she says.

Black women, who already have higher breast cancer mortality and typically present with more aggressive tumor biology at younger ages, would benefit from early and consistent screening.  

Women with dense breast tissue also have higher false-negative rates on mammogram and have increased risk for developing breast cancer. Factors such as these should tilt towards more intensive screening, Dr. Carcas advises.

“Additionally, patients with a family history and/or of Ashkenazi Jewish heritage who may harbor hereditary predispositions should consider continuing with annual screening,” she says.

Determining Your Personal Risk

All major U.S. societies agree that mammography screening should be available starting at age 40. However, Dr. Carcas advises that by age 25, all women should undergo a formal breast cancer risk assessment in order to direct their ongoing screening.  

“If their lifetime risk of developing breast cancer is greater than 20%, they are considered to be high risk and should undergo annual screening with consideration of supplemental ultrasound and breast MRI,” says Dr. Carcas.

For the average risk woman, the conversation between the patient and her physician will be more nuanced, she says, with shared decision-making guiding the patient’s screening strategy.

“Depending on the individual’s preference and the recommendation of her gynecologist or primary care provider,” Dr. Carcas says, “the patient would screen with mammogram on an annual basis or biennially.”

Early Detection Saves Lives

Dr. Carcas notes that most women diagnosed with breast cancer would be grateful to have it diagnosed at an earlier stage.

“When breast cancer is detected early — at stage 1 or stage 2 — the patient is less likely to need chemotherapy and other aggressive modalities of treatment, and successful outcomes are much more typical,” she says.

Dr. Carcas says she plans to recommend annual screening to her patients and will “most certainly” offer ultrasound and MRI to those with dense breast tissue and/or elevated risk. 

But she worries about another possible impact of the new ACP screening guidance.

“I remain hopeful this new recommendation from ACP will not alter insurance coverage for patients undergoing screening — particularly in light of the differing recommendations among medical societies,” Dr. Carcas says.

Visit BaptistHealth.net/Mammo to learn more or call 786-573-6000 to schedule your appointment today.

You can also schedule your mammogram on the PineApp.